Top doctors: Treating rheumatoid arthritis

Everyone gets a bit creaky with age, and most people develop some aches and pains from osteoarthritis, when the joint cushioning wears away.

Here's what you should know about treating rheumatoid arthritis:

"A joint normally has a very thin lining, almost like Saran Wrap, that's very thin and produces nutrients for the joint," he said. In rheumatoid arthritis, "the tissue starts to grow like crazy," he explained. "There's uncontrolled growth of this very thin membrane, and it begins to almost look like a sea anemone, with fronds that can invade and destroy cartilage, bone, ligaments and tendons."

Treatment may include anti-inflammatory drugs -- they reduce swelling -- and medications that directly modify the way the immune system works, Furie said.

Over-the-counter painkillers like ibuprofen and naproxen may help treat pain and swelling, but "they are not innocuous drugs," warned Dr. Steven E. Carsons, chief of the Division of Rheumatology, Allergy and Immunology at Winthrop University Hospital. "They may interact with other medications prescribed for rheumatoid arthritis, and carry a risk of gastrointestinal ulceration and bleeding as well as altering kidney function. Recent data urge caution in patients having risk factors for heart disease."

Over the past decade, combo therapies have helped improve symptoms for many people with rheumatoid arthritis, Carsons said. Sixty-five to 70 percent get at least some relief when they take a combination of medications, he said.

In particular, Carsons said, doctors have been prescribing combinations of methotrexate (an immune-system dampener known by the brand names Rheumatrex and Trexall) and drugs known as biologic agents. Furie explained that biologic drugs target a specific molecule in the immune system, and it may take time to find the right combination of medications for a patient.

"That's something we couldn't do 12 years ago because there weren't all these drugs out there," Furie said. "Now there are all these choices. It's great for the patients."

"The impact of cost is felt most acutely regarding the biologic therapies, which may reach $10,000 to $20,000 yearly," Carsons said. "Plans often do not cover the entire expense." But, he said, "rheumatologists and their staffs are knowledgeable in working with payers, manufacturers and private foundations in order to obtain these medications for their patients at a reasonable out-of-pocket expense whenever possible."

The immune-dampening medications can boost the risk of infections like respiratory diseases, and there's debate over whether they may make cancer more likely, Furie said. "You can't subdue the immune system without affecting the immune system's ability to protect you from invaders," he explained.

Still, he said, the drugs can have major benefits in the long run because they preserve the integrity and function of joints. Methotrexate, for example, slows down the damage from rheumatoid arthritis, he said.

"A lot of patients are afraid to go on medications because they're afraid of side effects, and they say they're doing OK now," Furie said. "I'll counter with, 'You're doing OK now, but we want to make sure you're doing OK 30 years from now.' There's a balance to be struck between feeling better now and the long-term outlook."

RHEUMATOLOGISTS

This is the 18th installment of a 26-week series in which Newsday presents Castle Connolly's list of top Long Island doctors.

Winthrop Univ. Hosp.,

Div. Rheumatology,

120 Mineola Blvd.,

566 Broadway,

Div. Rheumatology & Allergy,

120 Mineola Blvd.,

Mineola; 516-663-2097

1157 Broadway,

North Shore Long Island

Jewish Health System,

2800 Marcus Ave.,

2 ProHealth Plaza,

1895 Walt Whitman Rd.,

277 Northern Blvd.,

315 Middle Country Rd.,

2 Pro Health Plaza,

242 Merrick Rd.,

1044 Northern Blvd.,

5 E. Main St.,

Huntington; 631-271-1640

975 Stewart Ave.,

222 Middle Country Rd.,

566 Broadway,

How they were picked

Castle Connolly Medical Ltd. is a health care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of doctors and the medical leadership of leading hospitals.

Castle Connolly's team of researchers follows a rigorous screening process to select doctors on national and regional levels. Using mail and telephone surveys, and electronic ballots, they ask physicians and the leadership of top hospitals to identify exceptional doctors. Careful screening of doctors' educational and professional experience is essential to the committee. Not every good physician makes the list. Rather, the list is a way for patients to get started on their search for the best medical professional. Newsday is not part of the selection process.

Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.

To see the whole list . . .

Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The softcover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.